Achieving Target Cholesterol Levels With Type 2 Diabetes is a Challenge

LDL-C test
LDL-C test
Diabetes is a major risk factor for cardiovascular disease, and many people with type 2 diabetes often don’t reach recommended cholesterol levels. Researchers measured the cholesterol levels in a group of people with the disease to find out why.

A real-world comparison between the lipid profiles of people with type 2 diabetes (T2D) and guideline recommendations for dyslipidemia suggests current treatment strategies are not sufficient to lower cholesterol or decrease cardiovascular (CV) risk in these patients. These findings were published in Acta Clin Croat.  

Researchers from Istanbul Medeniyet University Goztepe Training and Research Hospital in Turkey recruited 468 consecutive patients who were recommended for outpatient diabetes care. Patients were assessed for lipid profiles and stratified into CV risk categories. Real-world trends were compared with current America Diabetes Association (ADA) and European Society of Cardiology (ESC) recommendations. Both the ADA and the ESC suggest people with type 2 diabetes should aim for a low-density lipoprotein-cholesterol (LDL-C) level of less than 100 mg/dL.

The majority of the patients in the study were women (n=271), aged mean 58.1752 (standard deviation [SD], 10.2) years, had a body mass index (BMI) of 31.4815 (SD, 5.1) kg/m2, and glycated hemoglobin (HbA1C) of 8.7465% (SD, 2.2%).

The average LDL-C level was 129±38 mg/dL among all individuals, with a mean LDL-C level of 134.7±37 in those who were not on statin therapy.

Coronary heart disease (CHD) was diagnosed in 12% of the study group (n=56). Thirty-four percent of the CHD patients were not receiving statin therapy and had a mean LDL-C of 114±29 mg/dL. A total of 19% were on guideline-recommended high intensity statin therapy. A total of 4 patients had LDL-C levels of <70 mg/dL, which is within the range suggested by the ADA and ESC.

For those without CHD, the average LDL-C was 132±38 mg/dL. Among these patients, 67 were on statin therapy. Overall, 82% (n=384) of the patients in the study group did not reach the recommended LDL-C levels.

For the patients receiving statins (22%), the majority (65%) did not achieve the recommended LDL-C levels. Most of these individuals were receiving moderate intensity treatment (92%) despite not reaching LDL-C goals.

The average triglycerides level in the study patients was 179±87 mg/dL. A total of 14 patients were receiving fibrate treatment and had a mean triglyceride level 206±90 mg/dL.

Stratified by statin use, HbA1C was 8.8%±2% among non-users and 8.2%±2% for users (P =.01).

This study was limited by its observational design. Additionally, the researchers did not ask patients about their history of statin use.

The study authors concluded that 82.4% of the patients enrolled in the study  were not receiving ADA guideline-recommended intensive statin treatment, leading them to conclude that “a more pronounced approach for statin treatment is needed in patients with diabetes for both primary and secondary prevention of cardiovascular disease”, as well as additional patient and physician education.


Keskinler MV, Bozkurt I, Caklili OT, et al. Comparison of real world lipid profile of patients with type 2 diabetes and guideline recommendations. Acta Clin Croat. 2021;60(1):63-67. doi:10.20471/acc.2021.60.01.09